State Laws

Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.

State Law

Texas Admin. Code-Title 28-Part 1-Chapter 3-Subchapter X-Division 1. General Requirements

05/12/2025 Texas Section 3.3709

Annual Network Adequacy Report

Network Adequacy
State Law

Texas Admin. Code-Title 28-Part 1-Chapter 3-Subchapter X-Division 1. General Requirements

05/12/2025 Texas Section 3.3707

Waiver Due to Failure to Contract in Local Markets

Network Adequacy
State Law

California Code of Regulations-Title 10-Chapter 5-Subchapter 2-Article 6. Provider Network Access Standards for Health Insurance

05/09/2025 California Section 2240.15

Network Access Appointment Waiting Time Standards; Quality Assurance; Disclosure and Education

Network Adequacy
State Law

California Code of Regulations Title 28-Managed Health Care Division 1-The Department of Managed Health Care Chapter 2-Health Care Service Plans Article 7-Standards

05/08/2025 California Section 1300.67.2.2

Timely Access to Non-Emergency Health Care Services and Annual Timely Access and Network Reporting Requirements

Network Adequacy
State Law

Administrative Rules of Montana-Title 6-Chapter 6.6-Subchapter 6.6.59. Network Adequacy

05/06/2025 Montana Sections 6.6.8801, 6.68805, 6.6.8806, 6.6.8807, 6.6.8808, 6.6.8814, 6.6.8815, 6.6.8816, 6.6.8819, 6.6.8820, 6.6.8821, 6.6.8827, 6.6.8828, 6.6.8829, 6.6.8835, 6.6.8836, 6.6.8840, 6.6.8841, and 6.6.8842

Definitions; Access Plan Filing and Review Guidelines; Access Plan Updates; Access Plan Specifications; Access Criteria; Mandatory Coverage; Provider-Enrollee Ratio Requirements; Verification of Provider Credentials; Geographic Access Criteria; Exceptions to Geographic Access Criteria; Service Areas; Referral and Specialty Care Requirements; Continuity of Care and Transitional Care; Selecting and Changing Providers; Removal of Barriers to Access; Monitoring the Network; Letters of Intent; Responsibility of Contracted Services

 

 

Continuity of Care Post-Contract, Network Adequacy
State Law

Illinois Compiled Statutes-215 ILCS 124/-Network Adequacy and Transparency Act

04/19/2025 Illinois Sections 124/5, 124/10, 124/15, 124/20, 124/25 and 124/55

Definitions; Network adequacy; Notice of nonrenewal or termination; Transition of services; Network transparency; Uniform electronic provider directory information
notification forms

Anti-gag clause, Continuity of Care Post-Contract, Directories, Network Adequacy
State Law

Revised Code of Washington-Title 48-Chapter 48.49-Balance Billing Protection Act

12/19/2024 Washington Sections 48.49.003, 48.49.005, 48.49.010, 48.49.040, 48.49.070, 48.49.080, 48.49.090, 48.49.130, 48.49.135, 48.49.160, and 48.49.170,

Findings—Intent—2019 c 427; Short title; Definitions; Dispute resolution process—Determination of commercially reasonable payment amount; Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists; Health care provider—Requirement to provide certain information on website or upon consumer request—Requirement to submit network status information to carriers; Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information; Application of chapter to self-funded group health plans that elect to participate in balance billing protection provisions—Annual notice to commissioner; Determining the adequacy of provider networks—Required considerations; Allowed amounts paid to nonparticipating providers; Application of state and federal requirements—Applicability information access—Waivers prohibited

Directories, Network Adequacy, OON-Payment Issues
State Law

Maryland Admin. Code-Title 31-Subtitle 10-Chapter 44. Network Adequacy

07/22/2023 Maryland Sections 31.10.44.02 through 31.10.44.11

Definitions; Network Adequacy Standards; Filing and Content of Access Plan; Travel Distance Standards; Appointment Waiting Time Standards; Provider-to-Enrollee Ratio Standards; Telehealth; Waiver Request Standards; Confidential Information in Access Plans

Network Adequacy
State Law

Illinois Admin. Code-Title 50. Insurance-Part 4540. Network Adequacy and Transparency

07/21/2023 Illinois Sections 4540.10 through 4540.80

Purpose and Scope; Applicability; Definitions; Filing Procedures; Material Changes to a Network; Provider Directory Audits; Notice of Nonrenewal or Termination; Confidentiality

Anti-gag clause, Directories, Network Adequacy
State Law

Insurance Code-Division 2-Part 2-Chapter 1. The Contract-Article 2. Transfer

08/29/2023 California Section 10133.54

Network Adequacy

Network Adequacy